Progress in the quality of care for newly diagnosed people with HIV in Spain (2004-2019).

Abstract

We monitored the quality of care for newly diagnosed people with HIV (PWH) in Spain, including linkage to care within 1month of HIV diagnosis (LC-1Mo) and viral suppression within 3months of HIV diagnosis (VS-3Mo). Longitudinal study based on The Cohort of the Spanish AIDS Research Network (CoRIS). We used logistic regression stratified by year of HIV diagnosis (2004-2013 and 2014-2019) to assess differences by sex, country of origin, HIV risk group, age, prior AIDS, HIV Viral Load, and CD4 cell count. The final analysis included 13,632 PWH: males 85%, men having sex with men (MSM) 61%, median age 35years. LC-1Mo increased from 42% (95% CI, 38%-46%) in 2004 to 80% (95% CI, 77%-83%) in 2019 (P < 0.001). Median CD4+ cell counts at ART initiation increased from <250/mm3 in 2004-2005 to >350/mm3 since 2012 (P < 0.001). The percentage of initial regimens based on integrase strand transfer inhibitors (INSTI) increased from 3% in 2004 to >70% from 2016 onwards (P < 0.001). VS-3Mo increased from 6% (95% CI, 4%-8%) in 2004 to 45% (95% CI, 41%-49%) in 2019 (P < 0.001). Worst results for LC-1Mo were found among PWH acquiring HIV by injection drug use and those born in Latin American Countries across all the study period. Care indicators have improved among newly diagnosed PWH in Spain over the last 15years. Removal of CD4 cell counts limitations, and probably the increasing use of INSTI-based regimens was decisive for the progress made.